Surgical therapy of pancreatic endocrine tumors

Due to the increasing use of cross-sectional imaging in the clinical setting, formerly rare pancreatic neuroendocrine tumors (NETs) are observed more and more frequently. Based on the symptomatology NETs are classified as functional or as nonfunctional tumors. The hallmarks of functional NETs are the syndromes they cause through the secretion of specific hormones while nonfunctional tumors do not cause specific clinical syndromes. This review focuses on the current standards of surgical therapy of NETs of the pancreas. Due to the lack of randomized controlled trials the evidence level is low in many instances and treatment guidelines are mostly based on smaller retrospective studies. The natural course of NETs is highly variable. Small, benign neoplasms are usually curable by surgical resection and ideally suited for laparoscopic therapy. The prognosis in other NETs is poor but aggressive surgical therapy can prolong survival even in advanced stages of disease.